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The Supports Intensity Scale™and

Person-Centered Planning Person-Centered Planning for for

Providers of MR/ID Waiver ServicesProviders of MR/ID Waiver ServicesAnd ICF’s/MRAnd ICF’s/MR

Office of Intellectual Disability SupportsOffice of Intellectual Disability Supports

Dept of Behavioral Health and Developmental ServicesDept of Behavioral Health and Developmental Services

ORIENTATION TO THE VIRGINIA ORIENTATION TO THE VIRGINIA PROJECTPROJECT

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Why the SIS™…..

The Supports Intensity Scale was developed by AAIDD over a five-year period in response to changes in how society views and relates to people with disabilities.

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AAIDD

is the largest association in the world for people with developmental disabilities.

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SIS™ Makes Sense For Virginia #1:

SIS™ reflects a a positive way of thinking about an assessment, focusing on the support needs for the individual to be successful, not on his or her deficits.

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SIS™ Makes Sense For Virginia #2

SIS uses a small group interview:

To engage the individual and other

respondents

To consider supports needed to meet

individual needs and promote

personal growth.

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SIS™ Makes Sense For Virginia #3

It has reliability “What is Reliability?” The information is:

- Dependable - Consistent - Un-changing - Desired

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What makes an assessment reliable?

We can depend on the scores, teams, and interviewers to be consistent

When a person changes residences, the score will be the same, as long as the conditions and environments are similar

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What makes an assessment reliable?

This information then would result in an unchanging score that is desired to help with planning

Thus, the rationale for doing the SIS every three years

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What Does “Supports” Mean in the SIS Assessment?

SupportsIntensity Scale™

SIS®

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“Supports” mean the assistance the individual needs to do something successfully.

“Success” means a level of performance, involvement, and participation in an activity that is comparable to that of typical adults without disabilities.

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“Supports” are… Those things needed to have a life like

yours and mine Home Friends and relationships Choice Paid work Participation in community activities

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What Does “Intensity” Mean in the SIS Assessment?

SIS®SupportsIntensity Scale™

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Intensity is the level of support an individual needs.

Lots of support.

Some support.

A little support.

SUPPORT

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What Does “Scale” Meanin the SIS Assessment?

SIS®

SupportsIntensity Scale™

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“Scale ” means a standardized way to measure support needs.

Score = 1-2-3-4-5-6-

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The SIS™ assessment measures support needs to find out:

what type of support is needed

how often support is needed how much support is needed

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What will an Interview be like?

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The interview may include:

The Interviewer and

The Individual Support

Coordinator/CM Guardians,

Significant others, or Family members

1-2 staff from home

1-2 staff from day or work

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Each person at the interview:

• Should have known the individual for at least 3 months.

• Should know about supports needed

• Should be prepared and feel free to share information when asked

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Together, the group meets with the interviewer.

This will take about 2 hours.

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During the interview-YOU and others should:

Answer all the questions even if they don’t seem to apply to the individual now or in the future.

Be ready to describe supports if asked. This is what makes the assessment picture complete and person-centered.

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What if YOU know any topics that may:

make the individual feel uncomfortable or

trigger uncomfortable responses

Help the individual tell the interviewer or

Tell the interviewer yourself, prior to starting the interview.

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Who is the interviewer?

An experienced person who is trained to do SIS assessments will ask

the questions.

Training NotebookCase Manager

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What will the interviewer do?

Explain the interview

process.

Ask you the interview questions.

Write down your answers or enter them on a computer.

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The Interviewer will work with the group to reach agreement about supports needed, because…

Not everyone sees the individual the same way or doing the same things

Some items have many parts

Individuals need different supports in different settings

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What Kind of Questions Will Be Asked at the Interview?

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The interviewer will ask about:

All parts of a individual’s everyday life

Some areas that are very personal

Things that may not be happening now but could happen in the future

Let’s look at sample questions in each

section of the SIS…..

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Section 1: Activity Domains

Home Living Community Living Lifelong Learning Employment Social Activities Health & Safety

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Bathing-Personal Grooming:(Showering, bathing, personal cleanliness, and proper grooming)

Does___ need support for personal grooming?If so, what type of support is needed?How often is it needed?How much time does the support take each day?

Example: In Home Living, a question you will be asked about is:

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Transportation:(Getting from place to place in the community - going shopping, to the bank, to leisure activities)Does___ need support for transportation?If so, what type of support is needed?How often is it needed?How much time does the support take on a day it occurs?

Example: In Community Living, a question you will be asked about is:

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Learning Health & Physical Education Skills:(Learn skills in how to stay healthy, fit, and safe) Does___ need support to follow a diet or exercise? If so, what type of support is needed? How often is it needed? How much time does the support take?

Example: In Life Long Learning, a question you will be asked about is:

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Changing Job Assignments:(Difficulty in adapting to changes in work tasks, supports for job transition)

Does___ need support at times of change?If so, what type of support is needed?How often is it needed? When needed, how much time does the support take?

Example: In Employment, a question you will be asked about is:

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Socializing in the home:(Effective interaction with roommates and family)

Does___ need support to socialize?If so, what type of support is needed?How often is it needed?How much time does the support take?

Example: In Social Activity, a question you will be asked about is:

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Example: In Health & Safety, a question you will be asked about is:

Taking medication:(At the correct time and prescribed level)

How often is medication taken each day? How much support is needed to take

medication? How long does it take someone to help with daily

medication?

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Section 2: Protection and Advocacy

Advocating for Self Managing Money - Finances Protecting Self -Exploitation Participating Self-Advocacy Obtaining Legal Services Exercising Responsibilities Making Choices Decisions Advocating For Others

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Advocating For Self:(Expressing personal preferences including

wants and needs, understanding choices and decisions)

What type of support is needed in advocacy? How often is it needed? How much daily support time is needed?

Example: In Protection and Advocacy, a question you will be asked about is:

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Section 3: Exceptional Medical and Behavioral Supports

Exceptional Medical Support Needs Respiratory Care Feeding Assistance Skin Care Other Exceptional Medical

Care

Exceptional Behavioral Support Needs Externally directed

destructiveness - Injury to Others

Self-directed destructiveness - Injury to Self

Sexual Issues

Other Exceptional Behavioral Support

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Skin Care:(Turning or positioning: is assistance needed to

reposition in chair or bed to prevent sores?)

If “YES” What is the level of support needed?The scale changes to: No Support Some Support Extensive Support

Example: In Exceptional Medical Supports, a question you will be asked about is:

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Externally-Directed Destructiveness:(Aggression against others, stealing, arson, etc.)

If “YES” What is the level of support needed?

The scale changes to: No Support Some Support Extensive Support

Example: In Exceptional Behavior Supports, a question you will be asked about is:

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SECTION 4: RISK ASSESSMENT

Caretaker and Environmental Risks

Individual Behavioral RisksOther Health Risks

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Example: In Additional Heath Risks, a question you will be asked about is:

RISK OF FALLING (Issues that effect balance and falling)

Does _______ have an unsteady gait, seizures or issues that effect balance?

The scale changes The scale changes toto: :

- No Support- No Support- Some Support- Some Support- Extensive - Extensive SupportSupport

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The SIS™ gives the opportunity to record what is important “TO” the person and “FOR” the person.

These are based on the person-centered thinking training that will be offered to teams throughout the year.

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Important “TO” the Person What individuals say “in their own words’ What individuals say with "their own

behavior” What you hear depends on what you are

listening for: ELP Learning Community 2005

LISTEN

UNDERSTAND

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IMPORTANT “FOR” THE PERSON ONLY THOSE THINGS AROUND:

ISSUES OF HEALTH, SAFETY and Well-being

WHAT OTHERS SEE AS IMPORTANT TO HELP THE PERSON

What is needed to BE VALUED MEMBERS OF THEIR COMMUNITY ELP Learning Community 2005

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SIS™ measures the difference

Current expectations/abilities/support

Typical adult expectations/abilities

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The Implementation Schedule

The SIS will be administered every three years, for every individual in Waiver or a training center.

Each year only 1/3 of the waiver individuals will be evaluated by each CSB/TC and the individual’s team.

The Person Centered plan will be completed every year.

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This Means a Time Frame of:

Year one: PCP and Full SISYears two and three: PCP and

Risk assessmentYear four: PCP and Full SIS™

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IMPLEMENTATION (cont.) Risk Assessment Section 4 is a pull out

that is updated annually as part of the planning process

A new SIS is not necessary when an individual moves from one living situation in the community or type to another. Supports for an individual should remain the same regardless of where the person lives or works.

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A new SIS™ is needed when: An individual

is new to the Waiver moves from a long term medical

environment (e.g. Nursing Facility) medical or psychological condition changes,

Providers would use the current SIS or assessment for the initial period (per your regulatory requirements).

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The SIS™ Interview Site Interviews may occur anywhere that allows for

uninterrupted privacy

The individual and interview team should agree on a location where everyone will feel comfortable

The location should be chosen to help facilitate participation by the individual

Interviews may occur at these or other locations:The individual’s or a family member’s home The individual’s day service location, provider

meeting room, community meeting room.Support Coordinator/CM Offices

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Things To Know About the Interview

SIS™ is not a test. There are no “right” or “wrong” answers - just a guided conversation with all participants

It's important for all participants to give their input & be as accurate as possible

Since SIS is a standardized assessment, we must answer all the questions even if they don't seem to relate to the consumer now or even in the future

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Things to Tell the Interviewer Before the Interview…

How the individual prefers to participate and communicate

If any topics of discussion may "trigger" uncomfortable responses from the individual and how to best accommodate how information is gathered

Any accommodations which may be needed for any participant

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An Invitee is called a “Respondent” and is any person designated to answer questions about the support needs of the individual:Should know the person for at least 3 months

Should have regular (preferably daily) interaction with them in settings where support is needed

Should be prepared to provide responses that accurately reflect the support need.

SIS Interview Participants

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SIS Interview Respondents The right respondents can make all the

difference in capturing an accurate picture of an individual’s support needs

As mentioned earlier, an interview may include:The individualGuardian or family member if appropriateOne or two staff from day program providerOne or two staff from residential provider Support coordinator Interviewer

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SIS Respondents: Direct Support Staff

Agencies should designate staff from each of the residential and day/employment services to serve as respondents. Information from both residential and day services is essential.

To be prepared, designated respondents should review information from the ISP, “Essential

Information” & other relevant information prior to the interview.

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SIS Respondent: The Individual The individual should participate in at

least part of the interview, and use their communication devices, if needed

In unique situations the individual may be unable or decide not to be interviewed. If so, The individual or team should identify who will

represent them (family member, advocate, or support coordinator)

The Interviewer should try to meet the individual at some point before the interview or prior to finalizing the report to explain about the meeting.

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Roles and Responsibilities of

Case Managers/Interviewers of SIS™

Support for Team Members/Standardization of Administration

Help Team Members Understand the Score and Interpret their responses

Help Team Members Develop Outcomes in the Person-Centered Planning Process

Follow Up and Monitor Plan

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The Individual and Identification of Other Respondents

“The interview is about the individual’s life. It is not the family's or provider’s interview.” AAIDD 2008

Respondents should be given the opportunity to express their opinions about individuals invited to the SIS interview, & their preferences considered along with those of others putting the interview team together.

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Identification of Other Respondentscont.

An individual may assist in identifying a family member and/or an advocate to participate

This is similar to the process used for ISP meeting.

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SIS™ Respondents: Service Providers

How Many Staff Can Attend?

In most cases, each service agency would select one respondent who knows and works with the individual on a daily basis.

One additional staff respondent from each of services area may attend if a more thorough understanding of the supports an individual needs can be provided.

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SIS™ Respondent: Support Coordinator/CM

If the Support Coordinator/CM is familiar with the individual’s support needs, they will participate as a respondent.

If the Support Coordinator does not meet the criteria as a respondent, they might participate as an observer if they are not the interviewer.

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When a SIS™ is completed -Respondents may..

Give input to the Interviewer and will use the SIS instead of their current assessments for any individual they support once a SIS is completed.

Use current process until a SIS is completed (during the phase in).

Receive on-line print outs of the reports which are distributed after SIS is completed prior to development of the annual plan.

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Team meetings….. Team meeting might look different

when completed in a person-centered way.

The SIS™ is best completed by the team prior to the annual gathering with review and use during the Person-Centered process.

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Level Of Care/LOF

Information on the SIS™ should be consistent with the information from the LOF

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SIS™/ISP FrameworkOne Team

Assessment/One plan/Shared outcomesPartners/Circles of supportSelf-directionHealth and safetyRegulatory compliancePerson-Centered Practices Leadership Team 5

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Changes in LanguageClient/Consumer = Individual

Case Manager = Support Coordinator

Service Plan = Support Plan

Training = Learning

Assistance = Supports

Specialized Supervision = Safety Supports

Interventions/Strategies = Support Instructions

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The Person-Centered Plan Focuses on the individual and what

he/she wants in life

Contains the balance of important “TO” and “FOR” that leads to the individual’s desired outcomes.

Describes the details of how supports will be provided to achieve the outcomes.

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Before plannin

g

During plannin

gAfter

planning

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The Modules of the ISP:

1. Essential information

2. Personal Profile

3. Shared planning

4. Agreements

5. Support Plans

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List of Components…..

I. Essential Information

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Risk assessment

SIS

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II. Personal ProfileConsiders “a good life”/ talents and contributions

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II. Personal ProfileConsiders what’s WORKING AND NOT WORKING

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III. Shared PlanningConsiders what’s IMPORTANT TO the individual

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…And FOR the individual’s life

III. Shared Planning

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Planning is evaluated for success

III. Shared Planning

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IV. Shared Agreements

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IV. Shared Agreements

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Part V: Plan for Supports

Optional format

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V. Plan for Supports

Person-centered

descriptio

ns

Supports tailored to individual preferences

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Schedule to meet agreements

V. Plan for Supports

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Keeping track

V. Plan for Supports

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Ongoing notes and learning

M. Smull

V. Plan for Supports

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What? Ongoing review and improvements

V. Plan for Supports

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The PC Process Tells Us The Individual’s:

Health and safety issues

Description of the good life

What’s working and not working

Desired outcomes

Supports to reach those outcomes

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AND THE SIS™ TELLS YOU…..

What type of supports a person will need…..

The intensity of those supports…..

The frequency of supports…..

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Reliable Assessment Identifies Support Needs Identifies “to”s and “for”s

Person-Centered Plan

QualitySupport

Good Life

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Questions?More info:

www.dmhmrsas.virginia.govMR/IDS web pages

www.AAIDD.orgSupports Intensity Scale™

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Thank you!The Picture Communication Symbols

©1981–2008 by Mayer-Johnson LLC. All

Rights Reserved Worldwide. Used with

permission.

Thanks also to The Pennsylvania Training Partnership for People

with Disabilities and Families and

the Oregon Office of Developmental

Disabilities for the use of their slide

presentations which were adapted for

Virginia.